Healthcare Provider Details

I. General information

NPI: 1063340016
Provider Name (Legal Business Name): DAVID ANDERSEN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3607 W 26TH ST
CHICAGO IL
60623-3961
US

IV. Provider business mailing address

1210 CHICAGO AVE APT 204
EVANSTON IL
60202-6514
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-9525
  • Fax:
Mailing address:
  • Phone: 847-687-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038.014357
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: